Nutritional advice

Objectives:
Many studies have investigated the association between dietary iron intake and death due to cardiovascular disease (CVD), but the results were inconsistent. Therefore, this review article has been conducted.

Does dietary iron intake increase risk of death due to cardiovascular disease (cardiovascular disease mortality)?

Study design:
This review article included 19 prospective cohort studies including 720,427 participants (46,045 deaths due to cardiovascular disease).

Results and conclusions:
The investigators found when comparing the highest versus lowest level, the highest level of dietary heme iron intake significantly increased risk of death due to cardiovascular disease with 19% [pooled RR = 1.19, 95% CI = 1.01-1.39].

The investigators found every 1-mg/day increase in dietary heme iron intake significantly increased risk of death due to cardiovascular disease with 25% [pooled RR = 1.25, 95% CI = 1.17-1.33].

The investigators found every 1-mg/day increase in dietary heme iron intake significantly increased risk of death due to stroke with 17% [pooled RR = 1.17, 95% CI = 1.04-1.32].

The investigators found the association between dietary iron intake and cardiovascular disease mortality was linear [p nonlinearity > 0.05].

The investigators concluded higher dietary intake of heme iron (at least 1-mg/day) is associated with a greater risk of cardiovascular disease mortality. Therefore, reducing consumption of heme iron may help to prevent premature death due to cardiovascular disease.

Original title:
Dietary iron intake and risk of death due to cardiovascular diseases: A systematic review and dose-response meta-analysis of prospective cohort studies by Han M, Guan L, […], Lu J.

Link:
https://pubmed.ncbi.nlm.nih.gov/32674239/

Additional information of El Mondo:
Find more information/studies on significant/cohort studies, iron consumption and cardiovascular disease right here.

Food items of heme iron are:

• Beef or chicken liver
• Beef
• Canned light tuna
• Canned sardines
• Organ meats
• Oysters, clams, mussels
• Poultry

Objectives:
Previous studies lack consistent conclusions as to whether astaxanthin is actually linked to various health benefits as claimed. Therefore, this review article has been conducted.

Is there a causal relationship between astaxanthin consumption and improvements in risk factors for diabetes or cardiovascular disease?

Study design:
This review article included 14 RCTs.

Results and conclusions:
The investigators found that astaxanthin consumption was not associated with FBS, HbA1c, TC, LDL-C, TG, BMI, BW, DBP and SBP.

The investigators found that astaxanthin consumption was associated with an increase in HDL cholesterol levels [WMD = 1.473 mg/dL, 95% CI = 0.319 to 2.627, p = 0.012].

The investigators found that astaxanthin consumption during ≥12 weeks was associated with a decrease in CRP levels [WMD = -0.528 mg/L, 95% CI = -0.990 to -0.066].

The investigators found that >12 mg/day astaxanthin consumption was associated with a decrease in CRP levels [WMD = -0.389 mg/dL, 95% CI = -0.596 to -0.183].

The investigators concluded that astaxanthin consumption is causally associated with an increase in HDL cholesterol levels (good cholesterol) and a decrease in CRP levels for >12 mg/day astaxanthin consumption during ≥12 weeks. Significant associations are not observed for other outcomes.

Original title:
The effects of astaxanthin supplementation on obesity, blood pressure, CRP, glycemic biomarkers, and lipid profile: A meta-analysis of randomized controlled trials by Xia W, Tang N, [...], Zhu Y.

Link:
https://pubmed.ncbi.nlm.nih.gov/32755613/

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Find here more information/studies about astaxanthin consumption and cholestrerol.

Objectives:
Dyslipidemia is a common metabolic disease worldwide and also an important predisposing factor for cardiovascular diseases (CVDs). Coffee is loved by people all over the world; however, the association between coffee consumption and blood lipids has yielded inconsistent results. Therefore, this review article has been conducted.

Is there a causal relationship between coffee consumption and dyslipidemia?

Study design:
This review article included 12 RCTs.

Results and conclusions:
The investigators found pooled results showed that coffee consumption significantly increased total cholesterol (TC) levels [WMD = 0.21 mmol/L, 95% CI = 0.04 to 0.39, p = 0.017].  
Significant means that there is an association with a 95% confidence.

The investigators found pooled results showed that coffee consumption significantly increased triglyceride (TG) levels [WMD = 0.12 mmol/L, 95% CI = 0.03 to 0.20, p = 0.006].  
Significant because the calculated p-value of 0.006 was less than the p-value of 0.05.

The investigators found pooled results showed that coffee consumption significantly increased LDL cholesterol (bad cholesterol) levels [WMD = 0.14 mmol/L, 95% CI = 0.05 to 0.24, p = 0.003].  

The investigators found pooled results showed that coffee consumption had no significant effect on HDL cholesterol (good cholesterol) levels [WMD = -0.01 mmol/L, 95% CI = -0.06 to 0.04, p = 0.707].
No significant means that there is no association with a 95% confidence.

The investigators found dose-response analysis results revealed significant positive nonlinear associations between coffee consumption and the increase in total cholesterol, LDL cholesterol and triglyceride levels.

The investigators concluded that coffee consumption is associated with an elevated risk for dyslipidemia and cardiovascular diseases. So a reasonable habit of coffee consumption (3 cups/d) is essential for the prevention of dyslipidemia.  

Original title:
Effect of coffee consumption on dyslipidemia: A meta-analysis of randomized controlled trials by Du Y, Lv Y, […], Luo Q.

Link:
https://pubmed.ncbi.nlm.nih.gov/33239163/

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Find more information/studies on significant/RCTs/causal relationship, coffee consumption, lowering cholesterol levels and cardiovascular disease right here.

Dyslipidemia is elevation of plasma cholesterol, triglycerides (TGs), or both, or a low HDL cholesterol (good cholesterol) level that contributes to the development of atherosclerosis. Atherosclerosis is the main underlying cause of cardiovascular disease (CVD).

Objectives:
Dietary sodium intake has received considerable attention as a potential risk factor of cardiovascular disease. However, evidence on the dose-response association between dietary sodium intake and cardiovascular disease risk is unclear. Therefore, this review article has been conducted.

Is there a dose-response association between dietary sodium intake and cardiovascular disease (CVD) risk?

Study design:
This review article included 36 cohort studies with a total of 616,905 participants.
The duration of follow-up ranged from 2.7 years to 29 years.

For dietary sodium intake assessment, 18 of the studies were based on twenty-four urinary excretion, 7 used food frequency questionnaires, 8 used 24 h dietary recall, 2 used dietary records; 1 used a self-administered questionnaire and 1 used single spot urine sodium excretion.
The daily dietary sodium intake ranged from 1.0 to 7.5 g.

The mean score (± standard deviation) for the quality of the included studies was 8.0 ± 1.0 according to the Newcastle-Ottawa Scale.

Results and conclusions:
The investigators found compared with individuals with low sodium intake, individuals with high sodium intake had an 19%-higher adjusted risk of cardiovascular disease [rate ratio = 1.19, 95% CI = 1.08 to 1.30].

The investigators found in dose-response meta-analysis that the risk of cardiovascular disease significantly increased by 6% when 1 g dose of sodium was ingested [rate ratio = 1.06, 95% CI = 1.01 to 1.11].

The investigators concluded that high sodium intake is an important risk factor of cardiovascular disease (CVD) and in dose-response meta-analysis, every 1 g of dietary sodium intake increases the risk of cardiovascular disease by 6%.

Original title:
Dietary Sodium Intake and Risk of Cardiovascular Disease: A Systematic Review and Dose-Response Meta-Analysis by Wang YJ, Yeh TL, [...], Chien KL.

Link:
https://www.mdpi.com/2072-6643/12/10/2934/htm

Additional information of El Mondo:
Find more information/studies on salt consumption and cardiovascular disease right here.

1 gram salt (sodium chloride) = 0.4 gram sodium.

Objectives:
Epidemiological studies on the impact of fish consumption on coronary heart disease (CHD) incidence have shown inconsistent results. Therefore, this review article has been conducted.

Does dietary intake of fish reduce coronary heart disease incidence and mortality?

Study design:
This review article included 40 prospective cohort studies (22 studies investigated the association between fish consumption and coronary heart disease incidence (28,261 persons with coronary heart disease and 918,783 participants) and 27 studies investigated the association between fish consumption and coronary heart disease mortality (10,568 events and 1,139,553 participants)).

No evidence of publication bias was found.

Results and conclusions:
The investigators found higher fish consumption was significantly associated with a 9%-lower coronary heart disease risk [RR = 0.91, 95% CI = 0.84 to 0.97, I2 = 47.4%].

The investigators found a significant correlation between fish consumption and coronary heart disease risk in the female subgroup [RR = 0.85, 95% CI = 0.78 to 0.92, I2 = 5.6%], the subgroup with a follow-up period of ≥10 years [RR = 0.91, 95% CI = 0.84 to 0.99, I2 = 51.5%] and the subgroup with an article quality of ≥7 points [RR = 0.90, 95% CI = 0.83 to 0.98, I2 = 50.6%].
However, it was not found in the male subgroup, the subgroup with a follow-up period of 10 years and the subgroup with an article quality of 7 points.

The investigators found higher fish intake was significantly associated with a 15%-lower coronary heart disease mortality risk [RR = 0.85, 95% CI = 0.77 to 0.94, I2 = 51.3%].

The investigators found the summary results did not change significantly in sensitivity analysis.

The investigators found dose-response analysis showed that the coronary heart disease incidence and mortality were reduced by 4%, respectively, with a 20 g/day increment in fish consumption.

The investigators concluded that a higher dietary intake of fish reduces coronary heart disease incidence and mortality. This finding has important public health implications in terms of the prevention of coronary heart disease. Since most of the research was conducted in male groups and Western countries, further research needs to be performed in female groups and other regions.

Original title:
Fish Consumption and Coronary Heart Disease: A Meta-Analysis by Zhang B, Xiong K, […], Ma A.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7468748

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In practice, higher fish consumption means at least twice a week of fish consumption (150 grams of fish at a time).

Objectives:
Observational studies regarding the putative associations between dietary intake of homocysteine metabolism-related B-vitamins (vitamin B6, folate and vitamin B12) and stroke risk have yielded inconsistent results. Therefore, this review article has been conducted.

Does dietary intake of vitamin B6, folate or vitamin B12 reduce stroke risk?

Study design:
This review article included 1 nested case-control study and 11 prospective cohort studies comprising 389,938 participants and 10,749 cases (persons with stroke).

The studies were published from 2002 through to 2019 and the follow-up period ranged from 4.2 to 19 years.

All 12 studies provided risk estimates adjusted for cigarette smoking and most studies also adjusted for other conventional risk factors, including BMI, energy intake, alcohol consumption, hypertension and/or physical activity.

Study quality scores ranged from 5 to 9; the mean quality score was 7.4.

There was no evidence of publication bias.

Results and conclusions:
The investigators found for the highest versus the lowest category of dietary vitamin B6 intake, a significantly reduced risk of 16% for stroke [RR = 0.84, 95% CI = 0.73 to 0.97, I2 = 48.8%].

The investigators found in dose-response analysis that each 0.5 mg/d increment in vitamin B6 dietary intake was associated with a 6% reduction in the risk of stroke [RR = 0.94, 95% CI = 0.89 to 0.99, I2 = 77.0%].

The investigators found for the highest versus the lowest category of dietary folate intake, a significantly reduced risk of 15% for stroke [RR = 0.85, 95% CI = 0.78 to 0.94, I2 = 11.5%].

The investigators found in dose-response analysis that each 100 μg/d increase in dietary folate intake was associated with a 6% reduction in the risk of stroke [RR = 0.94, 95% CI = 0.90 to 0.98, I2 = 46.8%].

The investigators found, in contrast, no significant association between dietary vitamin B12 intake and the risk of stroke, with an RR of 1.01 [95% CI = 0.97 to 1.06] per 3 μg/d increase.

The investigators concluded increased dietary intake of vitamin B6 (at least 0.5 mg/d) and dietary folate intake (at least 100 μg/d) is associated with a reduced risk of stroke, supporting the notion that increasing habitual folate and vitamin B6 intake may provide a small but beneficial effect with respect to stroke.

Original title:
Dietary Intake of Homocysteine Metabolism-Related B-Vitamins and the Risk of Stroke: A Dose-Response Meta-Analysis of Prospective Studies by Chen L, Li Q, [...], Wang F.

Link:
https://academic.oup.com/advances/advance-article/doi/10.1093/advances/nmaa061/5854025

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Find more information/studies on vitamin B6, folate and lowering of stroke right here.

Objectives:
Hypertension is regarded as a major and independent risk factor of cardiovascular diseases and numerous studies observed an inverse correlation between vitamin C intake and blood pressure. Therefore, this review article has been conducted.

Does a high serum vitamin C reduce blood pressure?

Study design:
This review article included 11 cross-sectional studies and 7 case-control studies. These studies comprised 22,200 observational subjects and were conducted from the year 1990 to 2017. Of the 18 articles, 14 were published in the English language and 4 were in Chinese.

Assessed with NOS, all the case-control studies yield a high quality averaging with 7.143 scores. And the result of AHRQ indicates a moderate quality with all cross-sectional studies scoring between 4 and 7.

Results and conclusions:
The investigators found random-effects model showed serum level of vitamin C of hypertensive subjects was 15.13 μmol/L lower than the normotensives [MD = -15.13, 95% CI = -24.19 to -6.06, p = 0.001, I2 = 98%].

The investigators found subgroup analysis showed that hypertensive subjects who took antihypertensive drugs had a 15.97 μmol/L lower serum vitamin C compared with normotensive ones.

The investigators found serum vitamin C had a significant inverse relation with both systolic blood pressure [Fisher′s Z = -0.17, 95% CI = -0.20 to -0.15, p 0.00001] and diastolic blood pressure [Fisher′s Z = -0.15, 95% CI = -0.20 to -0.10, p 0.00001].

The investigators concluded people with hypertension have a relatively low serum vitamin C and vitamin C is inversely associated with both systolic blood pressure and diastolic blood pressure.

Original title:
Association between Serum Vitamin C and the Blood Pressure: A Systematic Review and Meta-Analysis of Observational Studies by Ran L, Zhao W, […], Bu H.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7211237/

Additional information of El Mondo:
Find more information/studies on vitamin C and lowering of blood pressure right here.

Objectives:
Is there a causal relationship between black or green tea consumption and lowering blood pressure in subjects with elevated blood pressure (BP) or hypertension?
 
Study design:
This review article included 5 RCTs with 408 individuals.

None of the studies reported any side effects.

Results and conclusions:
The investigators found regular tea consumption significantly reduced systolic blood pressure [WMD = -4.81 mmHg, 95% CI = -8.40 to -1.58, p = 0.004] in subjects with elevated blood pressure (BP) or hypertension.

The investigators found regular tea consumption significantly reduced diastolic blood pressure [WMD = -1.98 mmHg, 95% CI = -3.77 to -0.20, p = 0.029] in subjects with elevated blood pressure (BP) or hypertension.

The investigators found, however, excluding the most heterogeneous trials showed that regular tea intake significantly reduced systolic blood pressure and diastolic blood pressure by about -3.53 and -0.99 mmHg, respectively.

The investigators found based on meta-regression findings, the longer the duration of tea intake (≥3 months), the higher the decrease in both systolic blood pressure and diastolic blood pressure.

The investigators found categorized studies, according to the tea type, revealed that the hypotensive effects of green tea were more pronounced compared to black tea.

The investigators concluded regular tea consumption, particularly green tea during ≥3 months reduces systolic blood pressure and diastolic blood pressure in subjects with elevated blood pressure (BP) or hypertension. Hence, it may be applicable to physicians, health care providers and particularly hypertension patients.

Original title:
The Effects of Regular Consumption of Green or Black Tea Beverage on Blood Pressure in Those With Elevated Blood Pressure or Hypertension: A Systematic Review and Meta-Analysis by Mahdavi-Roshan M, Salari A, […], Ashouri A.

Link:
https://www.sciencedirect.com/science/article/abs/pii/S0965229919316899?via%3Dihub

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Objectives:
Epidemiologic studies, including trials, suggest an association between potassium intake and blood pressure (BP). However, the strength and shape of this relationship is uncertain. Therefore, this review article has been conducted.

What is the strength and shape of the relationship between potassium intake and blood pressure (BP)?
 
Study design:
This review article included 32 RCTs with a duration ≥4 weeks using the recently developed 1‐stage cubic spline regression model. This model allows use of trials with at least 2 exposure categories.
Most trials were conducted in adults with hypertension using a crossover design and potassium supplementation doses that ranged from 30 to 140 mmol (1173 and 5474 mg) per day.

Results and conclusions:
The investigators found a U‐shaped relationship between 24‐hour active and control arm differences in potassium excretion and blood pressure (BP) levels, with weakening of the blood pressure reduction effect above differences of 30 mmol/d and a blood pressure increase above differences ≈80 mmol/d.

The investigators found achieved potassium excretion analysis also identified a U‐shaped relationship. The blood pressure lowering effects of potassium supplementation were stronger in participants with hypertension and at higher levels of sodium intake.

The investigators found blood pressure increased with high potassium excretion in participants with antihypertensive drug‐treated hypertension but not in their untreated counterparts.

The investigators concluded that an adequate intake of potassium (≤30 mmol (1173 mg) per day) is desirable to achieve a lower blood pressure level but excessive potassium supplementation (>80 mmol (3128 mg) per day) should be avoided, particularly in specific subgroups.

Original title:
Potassium Intake and Blood Pressure: A Dose‐Response Meta‐Analysis of Randomized Controlled Trials by Filippini T, Naska A, […], Whelton PK.

Link:
https://www.ahajournals.org/doi/full/10.1161/JAHA.119.015719?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed&

Additional information of El Mondo:
Find more information/studies on potassium consumption and lowering of blood pressure right here.

Objectives:
Is there a causal relationship between tomato consumption and lowering effects on cholesterol, triglycerides or fasting blood sugar levels?
 
Study design:
This review article included 6 RCTs.

Results and conclusions:
The investigators found tomato consumption significantly reduced total plasma cholesterol levels [WMD = -4.39 mg/dL, 95% CI = -7.09 to -1.68, I2 = 48%, p = 0.05].

The investigators found tomato consumption significantly reduced plasma triglyceride (TG) levels [WMD = -3.94 mg/dL, 95% CI = -7.67 to -0.21, I2 = 90%, p = 0.001].
A higher reduction effect was found on younger participants.

The investigators found tomato consumption significantly reduced plasma LDL cholesterol (bad cholesterol) levels [WMD = -2.09 mg/dL, 95% CI = -3.73 to -0.81, I2 = 78%, p = 0.001].
A higher reduction effect was found on younger participants.

The investigators found tomato consumption significantly increased plasma HDL cholesterol (good cholesterol) levels [WMD = 2.25 mg/dL, 95% CI = 0.41 to 4.10, I2 = 97%, p = 0.001].

The investigators found tomato consumption had no significant effect on plasma fasting blood sugar levels [WMD = 0.59 mg/dL, 95% CI = -0.28 to 1.46, I2 = 95%, p = 0.001].

The investigators concluded that tomato consumption increases plasma HDL cholesterol (good cholesterol) levels and decreases plasma total cholesterol, LDL cholesterol (bad cholesterol) and triglyceride levels.

Original title:
Effect of Tomato Consumption on Fasting Blood Glucose and Lipid Profiles: A Systematic Review and Meta-Analysis of Randomized Controlled Trials by Li H, Chen, A, [...],Yin X.

Link:
https://pubmed.ncbi.nlm.nih.gov/32243013/

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Patients with heart disease often have high LDL cholesterol, low HDL cholesterol and high triglycerides levels.

Objectives:
Do dietary calcium intakes or calcium supplements increase risk of cardiovascular disease?
 
Study design:
This review article included 26 prospective cohort studies and 16 RCTs.

Results and conclusions:
The investigators found in cohort studies that dietary calcium intakes ranging from 200 to 1500 mg/d did not affect the risk of cardiovascular disease [relative risk = 0.96, 95% CI = 0.87 to 1.05].

The investigators found in cohort studies that dietary calcium intakes ranging from 200 to 1500 mg/d did not affect the risk of coronary heart disease [relative risk = 0.98, 95% CI = 0.88 to 1.08].

The investigators found in cohort studies that dietary calcium intakes ranging from 200 to 1500 mg/d did not affect the risk of stroke [relative risk = 0.94, 95% CI = 0.85 to 1.04].

The investigators found in RCTs that calcium supplements significantly increased risk of coronary heart disease with 20% [relative risk = 1.20, 95% CI = 1.08 to 1.33, I2 = 0.0%].

The investigators found in RCTs that calcium supplements significantly increased risk of myocardial infarction with 21% [relative risk = 1.21, 95% CI = 1.08 to 1.35, I2 = 0.0%].

The investigators concluded that 200-1500 mg/d calcium intake from dietary sources do not increase the risk of cardiovascular disease, including coronary heart disease and stroke, while calcium supplements increase coronary heart disease risk, especially myocardial infarction.

Original title:
The Evidence and Controversy Between Dietary Calcium Intake and Calcium Supplementation and the Risk of Cardiovascular Disease: A Systematic Review and Meta-Analysis of Cohort Studies and Randomized Controlled Trials by Yang C, Shi X, […], Sun G.

Link:
https://pubmed.ncbi.nlm.nih.gov/31625814/

Additional information of El Mondo:
Find more information/studies on calcium and lowering of blood pressure right here.

Objectives:
Is there a causal relationship between daily egg consumption and positive effects on blood pressure?
 
Study design:
This review article included 15 RCTs with a total of 748 participants and mean age range from 23.3 to 67.1 years old.

All included studies used whole egg as an intervention which varied from one egg/day to three eggs/day and duration of supplementation ranged from 3 to 12 weeks.

No evidence of publication bias was seen in the meta-analyse (review article) of systolic blood pressure [Begg’s p = 0.235, Eggers’s p = 0.433] and diastolic blood pressure [Begg’s p = 0.254, Eggers’s p = 0.267].

No heterogeneity was found among included studies.

Results and conclusions:
The investigators found, overall, egg consumption had no significant effect on systolic blood pressure [WMD = 0.046 mmHg, 95% CI = - 0.792 to 0.884, p = 0.914, I2 = 0.0%, p = 0.453] and diastolic blood pressure [WMD = -0.603 mmHg, 95% CI = -1.521 to 0.315, p = 0.198, I2 = 38.1%, p = 0.067].
Subgroup analyses had no effect on pooled results.
Sensitivity analysis indicated that excluding each trial did not significantly change the overall observed effects of egg consumption.

The investigators found nonlinear dose-response meta-analysis did not reveal a significant effect of egg consumption [p-nonlinearity = 0.76] and study duration on diastolic blood pressure [p-nonlinearity = 0.63].

The investigators found subgroup analyses based on study design, sex, population health status, obesity and hypertension status, diet adherence, study duration and amount of egg consumption did not affect the overall effects of egg consumption on systolic blood pressure and diastolic blood pressure values.

The investigators concluded that 1-3 eggs/day during 3 to 12 weeks have no effect on blood pressure. However, high-quality RCTs with longer durations are needed to further confirm the effects of egg consumption on blood pressure.

Original title:
Effect of Egg Consumption on Blood Pressure: a Systematic Review and Meta-analysis of Randomized Clinical Trials by Kolahdouz-Mohammadi R, Malekahmadi M, […], Soltani S.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7189334/

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Find more information/studies on causal relationship/significantly, egg consumption and lowering of blood pressure right here.

Objectives:
Does Alzheimer disease increase risk of stroke?

Study design:
This review article included 8 studies, representing 121,719 individuals (Alzheimer disease = 73,044 and non-Alzheimer disease = 48,675).

Results and conclusions:
The investigators found patients with Alzheimer disease had a significantly increased risk of 42% [relative risk = 1.42, 95% CI = 1.23 to 1.64] for hemorrhagic stroke.

The investigators concluded Alzheimer disease increases risk of hemorrhagic stroke.

Original title:
Risk of hemorrhagic and ischemic stroke in patients with Alzheimer disease: A synthesis of the literature by Waziry R, Chibnik LB, […], Hofman A.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/31949087

Additional information of El Mondo:
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Objectives:
Is there a causal relationship between strawberry consumption and positive effects on cardiovascular risk factors?
 
Study design:
This review article included 11 RCTs (6 for blood pressure, 7 for lipid profile, 7 for fasting blood glucose and 6 for C-reactive protein).

There was little evidence of heterogeneity in the analysis and no evidence of publication bias.

Results and conclusions:
The investigators found overall, strawberry consumption significantly reduced C-reactive protein (CRP) levels by 0.63 mg/L [95% CI = -1.04 to -0.22] but did not affect blood pressure, lipid profile or fasting blood glucose in the main analyses.

The investigators found stratified by baseline endpoint levels, that strawberry consumption significantly reduced total cholesterol levels among people with baseline levels >5 mmol/L [-0.52 mmol/L, 95% CI = -088 to -0.15] and reduced LDL-cholesterol levels among people with baseline levels >3 mmol/L [-0.31 mmol/L, 95% CI = -0.60 to -0.02].

The investigators concluded strawberry consumption reduces C-reactive protein (CRP) levels and improves total cholesterol and LDL-cholesterol (bad cholesterol) in individuals with high baseline levels (level at the beginning of the study).

Original title:
Effects of strawberry intervention on cardiovascular risk factors: a meta-analysis of randomized controlled trials by Gao Q, Qin LQ, […], Dong JY.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/32238201

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Objectives:
Does fish consumption decrease risk of cardiovascular disease, depression, mortality and cancer?
 
Study design:
This review article included a total of 34 meta-analyses of prospective observational studies, reporting summary relative risks (SRR) for 40 different outcomes obtained from 298 primary prospective cohort studies.

The summary relative risk (SRR) for each meta-analysis was recalculated by using a random-effects model.

Results and conclusions:
The investigators found moderate-quality evidence showed that each 100-g/d increment in fish consumption was associated with a 8% lower risk of all-cause mortality [SRR = 0.92, 95% CI = 0.87 to 0.97].

The investigators found moderate-quality evidence showed that each 100-g/d increment in fish consumption was associated with a 25% lower risk of cardiovascular mortality [SRR = 0.75, 95% CI = 0.65 to 0.87].

The investigators found moderate-quality evidence showed that each 100-g/d increment in fish consumption was associated with a 12% lower risk of coronary heart disease [SRR = 0.88, 95% CI = 0.79 to 0.99].

The investigators found moderate-quality evidence showed that each 100-g/d increment in fish consumption was associated with a 25% lower risk of myocardial infarction [SRR = 0.75, 95% CI = 0.65 to 0.93].

The investigators found moderate-quality evidence showed that each 100-g/d increment in fish consumption was associated with a 14% lower risk of stroke [SRR = 0.86, 95% CI = 0.75 to 0.99].

The investigators found moderate-quality evidence showed that each 100-g/d increment in fish consumption was associated with a 20% lower risk of heart failure [SRR = 0.80, 95% CI = 0.67 to 0.95].

The investigators found moderate-quality evidence showed that each 100-g/d increment in fish consumption was associated with a 12% lower risk of depression [SRR = 0.88, 95% CI = 0.79 to 0.98].

The investigators found moderate-quality evidence showed that each 100-g/d increment in fish consumption was associated with a 35% lower risk of liver cancer [SRR = 0.65, 95% CI = 0.48 to 0.87].

The investigators concluded evidence of moderate quality shows that 100-g/d fish consumption is associated with a lower risk of cardiovascular disease, depression, mortality and liver cancer and therefore, can be considered as a healthy animal-based dietary source of protein. Further research is needed for outcomes for which the quality of the evidence was rated low and very low, considering types of fish consumed, different methods of cooking fish and all potential confounding variables.

Original title:
Fish Consumption and the Risk of Chronic Disease: An Umbrella Review of Meta-Analyses of Prospective Cohort Studies by Jayedi A and Shab-Bidar S.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/32207773

Additional information of El Mondo:
Find more information/studies on fish consumption, cancer and cardiovascular disease right here.

Objectives:
Do fermented dairy foods and probiotics supplementation improve risk factors (such as metabolic syndrome, type 2 diabetes, cholesterol) of cardiovascular diseases?

Study design:
This review article included 20 prospective cohort studies and 52 RCTs.

Results and conclusions:
The investigators found in prospective cohort studies, that fermented milk was associated with a 4% reduction in risk of stroke, ischemic heart disease and cardiovascular mortality [RR = 0.96, 95% CI = 0.94 to 0.98].

The investigators found in prospective cohort studies, that yogurt intake was associated with a risk reduction of 27% [RR = 0.73, 95% CI = 0.70 to 0.76] for type 2 diabetes.

The investigators found in prospective cohort studies, that yogurt intake was associated with a risk reduction of 20% [RR = 0.80, 95% CI = 0.74 to 0.87] for metabolic syndrome development.

The investigators found in RCTs, that probiotic supplementation added into dairy matrices produced a greater reduction in lipid biomarkers than when added into capsules/powder in hypercholesterolemic subjects.

The investigators found in RCTs, that probiotic supplementation by capsules/powder produced a greater reduction in type 2 diabetes biomarkers than when added into dairy matrices in diabetic subjects.

The investigators found in RCTs, that probiotic supplementation by both treatments (dairy matrix and capsules/powder) resulted in a significant reduction in anthropometric parameters in obese subjects.

The investigators concluded fermented milk consumption is associated with reduced cardiovascular risk, while yogurt intake is associated with a reduced risk of type 2 diabetes and metabolic syndrome development in the general population. Furthermore, probiotic supplementation added into dairy matrices is beneficial for lowering lipid concentrations and reduce anthropometric parameters. Additionally, probiotic capsule/powder supplementation contributes to type 2 diabetes management and reduces anthropometric parameters. However, these results should be interpreted with caution due to the heterogeneity of the studies and the different probiotic strains used in the studies.

Original title:
Fermented Dairy Products, Probiotic Supplementation, and Cardiometabolic Diseases: A Systematic Review and Meta-analysis by Companys J, Pla-Pagà L, […], Valls RM.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/32277831

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Objectives:
Does tea consumption decrease risk of cardiovascular disease and all-cause mortality among adults?
 
Study design:
This review article included 39 prospective cohort studies.

Strength of evidence was rated as low and moderate (depending on study population age group) for cardiovascular disease-specific mortality outcome and was rated as low for cardiovascular disease events, stroke and all-cause mortality outcomes.

Results and conclusions:
The investigators found linear meta-regression showed that each cup (236.6 mL) increase in daily tea consumption (estimated 280 mg and 338 mg total flavonoids/d for black and green tea, respectively) was associated with an average 4% lower risk of cardiovascular disease mortality, a 2% lower risk of cardiovascular disease events, a 4% lower risk of stroke and a 1.5% lower risk of all-cause mortality.

The investigators found subgroup meta-analysis showed that each cup (236.6 mL) increase in daily tea consumption (estimated 280 mg and 338 mg total flavonoids/d for black and green tea, respectively) was associated with a 11% [pooled adjusted RR = 0.89, 95% CI = 0.83 to 0.96, p = 0.001, I2 = 72.4%, n = 4] lower risk of cardiovascular disease mortality in elderly individuals.

The investigators found subgroup meta-analysis showed that each cup (236.6 mL) increase in daily tea consumption (estimated 280 mg and 338 mg total flavonoids/d for black and green tea, respectively) was associated with a 8% [pooled adjusted RR = 0.92, 95% CI = 0.90 to 0.94, p 0.0001, I2 = 0.3%, n = 3] lower risk of all-cause mortality in elderly individuals.

The investigators found, generally, studies with higher risk of bias appeared to show larger magnitudes of associations than studies with lower risk of bias.

The investigators concluded that daily a cup (236.6 mL) of tea (estimated 280 mg and 338 mg total flavonoids/d for black and green tea, respectively) is associated with a lower risk of cardiovascular disease and all-cause mortality among elderly individuals.

Original title:
Dose-Response Relation between Tea Consumption and Risk of Cardiovascular Disease and All-Cause Mortality: A Systematic Review and Meta-Analysis of Population-Based Studies by Chung M, Zhao N, […], Wallace TC.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/32073596

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Objectives:
Does flaxseed supplementation decrease plasma lipoprotein(a) levels?

Study design:
This review article included 7 RCTs with 629 individuals.

Results and conclusions:
The investigators found flaxseed supplementation significantly reduced plasma lipoprotein(a) levels [MD = -2.06 mg/dL, 95% CI = -3.846 to -0.274, p = 0.024, I2 = 0%, p = 0.986].

The investigators found subgroup analysis also revealed that longer duration only showed significant lowering effect of flaxseed supplementation on plasma lipoprotein(a) levels.

The investigators concluded that long duration of flaxseed supplementation decreases plasma lipoprotein(a) levels. However, future well-designed and long-term clinical trials are required to confirm these results.

Original title:
Impact of flaxseed supplementation on plasma lipoprotein(a) concentrations: A systematic review and meta-analysis of randomized controlled trials by Hadi A, Askarpour M, […], Ghavami A.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/32073724

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Lipoprotein(a) is a risk factor for atherosclerosis and related diseases, such as coronary heart disease and stroke.

 

Objectives:
Vitamin C as a supplement to treat hypertension has been proposed. However, it remains controversial whether vitamin C can improve blood pressure in patients with primary hypertension. Therefore, this review article has been conducted.

Do vitamin C supplements reduce blood pressure in patients with primary hypertension?

Study design:
This review article included 8 RCTs involving 614 participants.
There was no publication bias.

Results and conclusions:
The investigators found vitamin C supplements significantly reduced systolic blood pressure in patients with essential hypertension [WMD  = -4.09, 95% CI = -5.56 to -2.62, p 0 .001, I2  =  35%, p = 0.15].

The investigators found vitamin C supplements significantly reduced diastolic blood pressure in patients with essential hypertension [WMD  = -2.30, 95% CI = -4.27 to -0.331, p  = 0 .02, I2 = 75%, p = 0 .0002].

The investigators found vitamin C supplements significantly reduced systolic blood pressure for the subgroup with an age ≥60 years and that with ≥35 participants [WMD = -3.75, 95% CI = -6.24 to -1.26, p  = 0 .003].

The investigators found vitamin C supplements significantly reduced diastolic blood pressure for the subgroup with an age ≥60 years and that with ≥35 participants [WMD = -3.29, 95% CI = -5.98 to -0.60, p  = 0 .02].

The investigators found in the subgroup analysis that vitamin C supplements during ≥6 weeks significantly reduced systolic blood pressure in patients with essential hypertension [WMD = -4.77, 95% CI = -6.46 to -3.08, p   0 .001].

The investigators found in the subgroup analysis that ≥500 mg/d vitamin C supplements significantly reduced systolic blood pressure in patients with essential hypertension [WMD  =  -5.01, 95% CI = -8.55 to -1.48, p  = 0.005, I2  =  44%, p =  0.13].

The investigators concluded ≥500 mg/d vitamin C supplements during ≥6 weeks reduce blood pressure in patients with primary hypertension. However, in view of the current level of evidence, large-scale trials should be conducted and attention should be paid to the evaluation of blood pressure variability.

Original title:
Effects of vitamin C supplementation on essential hypertension: A systematic review and meta-analysis by Guan Y, Dai P and Wang H.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7034722/

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Objectives:
Clinical trials examining the cardiovascular protective effects of quercetin in humans have reported conflicting results. Therefore, this review article has been conducted.

Do quercetin supplements reduce plasma lipid levels and blood pressure?

Study design:
This review article included 17 RCTs with a total of 896 participants.

Results and conclusions:
The investigators found pooled results showed that quercetin supplements significantly lowered both systolic blood pressure [WMD = -3.09 mmHg, 95% CI = -4.59 to -1.59, p = 0.0001] and diastolic blood pressure [WMD = -2.86 mmHg, 95% CI = -5.09 to -0.63, p = 0.01].
Neither lipid profiles nor glucose concentrations changed significantly.

The investigators found in subgroup analyses, significant changes in high-density lipoprotein (HDL or good) cholesterol and triglycerides were observed in trials with a parallel design and in which participants consumed quercetin for 8 weeks or more.

The investigators concluded quercetin supplements decrease blood pressure in humans. Moreover, participants who consume quercetin for 8 weeks or more show significantly changed levels of high-density lipoprotein cholesterol (good cholesterol) and triglycerides in trials with a parallel design.  

Original title:
Effect of quercetin supplementation on plasma lipid profiles, blood pressure, and glucose levels: a systematic review and meta-analysis by Huang H, Liao D, [...], Pu R.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/31940027

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Objectives:
Data from in vitro and animal studies support the preventive effect of tea (Camellia sinensis) against colorectal cancer. Further, many epidemiologic studies evaluated the association between tea consumption and colorectal cancer risk, but the results were inconsistent. Therefore, this review article has been conducted.

Does tea consumption reduce colorectal cancer risk?

Study design:
This review article included 20 cohort studies with 2,068,137 participants and 21,437 colorectal cancer cases.

Results and conclusions:
The investigators found that tea consumption had no significant association with colorectal cancer risk for the highest vs. lowest categories [combined RR = 0.97, 95% CI = 0.94-1.01, I2 = 24.0%, p = 0.093] among all studies.

The investigators found stratified analysis showed no significant differences in all subgroups.

The investigators found no significant association between tea consumption and colorectal cancer risk in male [combined RR = 0.97, 95% CI = 0.90-1.04].

The investigators found, however, tea consumption had a marginal significant inverse impact on colorectal cancer risk in female [combined RR = 0.93, 95% CI = 0.86-1.00].

The investigators found a significantly reduced risk of 10% for colorectal cancer for tea consumption among the female studies with no adjustment of coffee intake [RR = 0.90, 95% CI = 0.82-1.00, p  0.05].
However, this reduced risk was not significant among the female studies that adjusted for coffee intake [RR = 0.97, 95% CI = 0.87-1.09, p > 0.05].

The investigators concluded that tea consumption may reduce colorectal cancer risk in female. May reduced because this reduced risk was not significant among the female studies that adjusted for coffee intake.

Original title:
Tea consumption and colorectal cancer risk: a meta-analysis of prospective cohort studies by Zhu MZ, Lu DM, […], Liu ZH.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/32078065

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Objectives:
There are differences among the outcomes regarding cognitive impairment in heart failure (HF) because the evidence is fragmented and sample size is small. Therefore, this review article has been conducted.

Does heart failure increase risk of dementia?

Study design:
This review article included 12 studies with 2,406,680 heart failure patients.

Begg test, Egger tests and funnel plots showed no significant risks of publication bias.

Results and conclusions:
The investigators found heart failure significantly increased risk of all-cause dementia with 28% [OR/RR  =  1.28, 95% CI = 1.15 to 1.43, I2 = 70.0%, p    0.001].
Sensitivity analysis showed no changes in the direction of effect when any one study was excluded for the studies on associations between heart failure and all-cause dementia.

The investigators found no significant association between heart failure and risk of Alzheimer's disease [OR/RR  =  1.38, 95% CI = 0.90 to 2.13, I 2 =  74.8%, p =  0.008].
Sensitivity analysis showed no changes in the direction of effect when any one study was excluded for the studies on associations between heart failure and Alzheimer's disease.

The investigators concluded heart failure increases risk of all-cause dementia. In addition, large scale prospective studies are essential to explore the associations between heart failure and risk of Alzheimer's disease.

Original title:
Associations between heart failure and risk of dementia: A PRISMA-compliant meta-analysis by Li J, Wu Y, [...], Nie J.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7004760/

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Objectives:
The benefits of LDL cholesterol-lowering treatment for the prevention of atherosclerotic cardiovascular disease are well established. However, the extent to which these effects differ by baseline LDL cholesterol, atherosclerotic cardiovascular disease risk and the presence of comorbidities remains uncertain. Therefore, this review article has been conducted.

Does LDL cholesterol-lowering treatment reduce risk of major vascular events (a composite of cardiovascular mortality, non-fatal myocardial infarction, non-fatal ischaemic stroke or coronary revascularisation)?

Study design:
This review article included 52 RCTs with a total of 327,037 patients.

Results and conclusions:
The investigators found each 1 mmol/L reduction in LDL cholesterol (bad cholesterol) was associated with a 19% relative risk (RR) reduction for major vascular events [RR = 0.81, 95% CI = 0.78 to 0.84,  p 0.0001].

The investigators found similar reductions (per 1 mmol/L reduction in LDL cholesterol) in trials with participants with LDL cholesterol level of 2.60 mmol/L or lower, 2.61-3.40 mmol/L, 3.41-4.10 mmol/L and more than 4.1 mmol/L [p = 0.232 for interaction] and in a subgroup of patients who all had a baseline LDL cholesterol level less than 2.07 mmol/L [80 mg/dL: RR = 0.83, 95% CI = 0.75-0.92, p = 0.001].

The investigators found greater RR reductions in patients at lower 10-year atherosclerotic cardiovascular disease risk [change in RR per 10% lower 10-year atherosclerotic cardiovascular disease = 0.97, 95% CI = 0.95 to 0.98, p 0.0001] and in patients at younger age across a mean age of 50-75 years [change in RR per 10 years younger age = 0.92, 95% CI = 0.83 to 0.97, p = 0.015].

The investigators found no difference in RR reduction for participants with or without diabetes [p = 0.878 for interaction] and chronic kidney disease [p = 0.934 for interaction].

The investigators concluded for each 1 mmol/L LDL cholesterol lowering, the risk reduction of major vascular events is independent of the starting LDL cholesterol or the presence of diabetes or chronic kidney disease. Patients at lower cardiovascular risk and younger age might have a similar relative reduction in risk with LDL-cholesterol lowering therapies and future studies should investigate the potential benefits of earlier intervention.

Original title:
Intensive LDL cholesterol-lowering treatment beyond current recommendations for the prevention of major vascular events: a systematic review and meta-analysis of randomised trials including 327 037 participants by Wang N, Fulcher J, […], Lal S.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/31862150

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Objectives:
Evidence has shown that essential nutrients are highly correlated with the occurrence of esophageal cancer (EC). However, findings from observational studies on the associations between dietary carbohydrate, salt consumption and the risk of esophageal cancer remain controversial. Therefore, this review article has been conducted.

Does carbohydrate or salt consumption (dietary salt intake) increase risk of esophageal cancer?

Study design:
This review article included 11 case-control studies and 1 cohort study, examined carbohydrates consumption and 16 case-control studies and 2 cohort studies, examined salt consumption.

Results and conclusions:
The investigators found dietary carbohydrate intake significantly reduced risk of esophageal cancer with 38% [pooled OR = 0.62, 95% CI = 0.50-0.77].

The investigators found dietary salt intake significantly increased risk of esophageal cancer with 97% [OR = 1.97, 95% CI = 1.50-2.61] in case-control studies.

The investigators found dietary salt intake significantly increased risk of esophageal cancer with 4% [RR = 1.04, 95% CI = 1.00-1.08] in cohort studies.

The investigators concluded dietary salt intake increases risk of esophageal cancer.

Original title:
Associations of dietary carbohydrate and salt consumption with esophageal cancer risk: a systematic review and meta-analysis of observational studies by Banda KJ, Chiu HY, [...], Huang HC.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/31995192

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According to WHO, a high salt intake is a salt intake of more than 5 grams salt per day.

A diet with more than 5 grams salt per day is a diet with mainly products/meals with more than 0.25 grams salt per 100 kcal. Check here which products contain maximum 5 grams salt per 100 kcal.
Use the 7-points nutritional profile app to see whether your daily diet contains maximum 5 grams salt per 100 kcal.

 

Objectives:
Low-carbohydrate diets are associated with cardiovascular risk factors; however, the results of different studies are inconsistent. Therefore, this review article has been conducted.

Do low-carbohydrate diets (diets with less than 40 En% carbohydrates) reduce cardiovascular risk factors?

Study design:
This review article included 12 RCTs with a total of 820 in the observation group (intervention group or low carbohydrate group) and 820 in the control group. The largest sample size was 403 cases and the smallest was 42 cases. The patients’ ages ranged from 31 to 65 years old.
The intervention was a diet with less than 40 En% carbohydrates in the observation group and a diet with 45 En% to 55 En% carbohydrates in the control group.

Results and conclusions:
The investigators found compared with the control group, the triglyceride levels of the low-carbohydrate group (less than 40 En% carbohydrates) significantly decreased by 0.15 mmol/L [95% CI = -0.23 to -0.07, I2 = 75%, p = 0.001].
The results remained unchanged in the sensitivity analysis (after subtracting each of the included studies individually).

The results of the publication bias analysis showed that the funnel plot was not symmetric. The asymmetry of the funnel plot may have been caused by publication bias and other issues.

The investigators found in subgroup analyses, low-carbohydrate diet interventions lasting less than 6 months significantly decreased the triglyceride levels by 0.23 mmol/L [95% CI = -0.32 to -0.15] and those of 12-23 months decreased the levels by 0.17 mmol/L [95% CI = -0.32 to -0.01].

The investigators found compared with the control group, the plasma HDL-cholesterol level (good cholesterol) of the low-carbohydrate group significantly increased by 0.1 mmol/L [95% CI = 0.08 to 0.12, I2 = 41%, p = 0.02].
The results remained unchanged in the sensitivity analysis (after subtracting each of the included studies individually).

The investigators found in subgroup analyses, the increase in plasma HDL-cholesterol levels was 0.08 mmol/L [95% CI = 0.27 to 0.57] for interventions lasting less than 6 months, 0.12 mmol/L [95% CI = 0.09 to 0.15] for those lasting 6-11 months, 0.12 mmol/L [95% CI = 0.08 to 0.15] for those lasting 12-23 months and 0.08 mmol/L [95% CI = 0.04 to 0.12] for those lasting 24 months. 

The investigators found compared with the control group, the serum total cholesterol level of the low-carbohydrate group significantly increased by 0.13 mmol/L [95% CI = 0.08 to 0.19].
The results remained unchanged in the sensitivity analysis (after subtracting each of the included studies individually).

The investigators found compared with the control group, the plasma LDL-cholesterol level (bad cholesterol) of the low-carbohydrate group significantly increased by 0.11 mmol/L [95% CI = 0.02 to 0.19, I2 = 71%, p = 0.0001].
The results remained unchanged in the sensitivity analysis (after subtracting each of the included studies individually).

The investigators found compared with the control group, the body weight of the low-carbohydrate group significantly decreased by 1.58 kg [95% CI = -1.58 to -0.75, I2 = 49%, p = 0.01].
The results remained unchanged in the sensitivity analysis (after subtracting each of the included studies individually).

The investigators found in subgroup analyses, the decrease in body weight was 1.14 kg [95% CI = -1.65 to -0.63] for interventions lasting less than 6 months and 1.73 kg [95% CI = -2.7 to -0.76] for those lasting 6-11 months.

The investigators found compared with the control group, the overall systolic blood pressure of the low-carbohydrate group significantly decreased by 1.41 mmHg [95% CI = -2.26 to -0.56, I2 = 0%, p = 0.84].
The results remained unchanged in the sensitivity analysis (after subtracting each of the included studies individually).

The investigators found in subgroup analyses, the overall systolic blood pressure significantly decreased by 2.97 mmHg [95% CI = -4.62 to -1.31] in the group that received interventions lasting less than 6 months.

The investigators found compared with the control group, the diastolic blood pressure of the low-carbohydrate group significantly decreased by 1.71 mmHg [95% CI = -2.36 to -1.06, I2 = 14%, p = 0.29].
The results remained unchanged in the sensitivity analysis (after subtracting each of the included studies individually).

The investigators found in subgroup analyses, the diastolic blood pressure significantly decreased by 2.76 mmHg [95% CI = -4.07 to -1.46] in the group that received interventions lasting less than 6 months and 2.11 mmHg [95% CI = -3.28 to -0.93] for those lasting 6-11 months.

The investigators concluded low-carbohydrate diets (diets less than 40 En% carbohydrates) have beneficial effects on cardiovascular risk factors at less than 6 months and 6-11 months, but after 2 years of a low-carbohydrate diet, there is no significant effect on cardiovascular risk factors.

Original title:
The effects of low-carbohydrate diets on cardiovascular risk factors: A meta-analysis by Dong T, Guo M, [...], Chen B.

Link:
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0225348

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40 En% carbohydrates means that the total amounts of carbohydrate make up for a 40% of the total kcal of the diet. The easiest way to follow this diet is to choose only meals/products that also contain 40 En% carbohydrates. These products in the supermarket contain 40 En% carbohydrates.